Insomnia, Restless Leg Syndrome, and Parkinson’s disease

Do you have Parkinson’s disease and have a hard time getting to sleep, or staying asleep? Sleep problems, including insomnia, are reported as one of the more frequent non-motor symptoms that occur in Parkinson’s disease (PD).

Insomnia can be miserable

In a review, researchers found that in published studies, insomnia was reported on average in 40.9% of subjects.1 While some people fall asleep during the daytime without warning, others lie awake for hours, or wake up frequently at night. And lack of sleep is pure misery. It can make you feel sleepy all day, when you need to be alert. 2

There are many possible reasons for insomnia in PD besides restless leg syndrome (RLS), including tremor and several of the medications. But since it’s fairly common, let’s examine RLS.

Restless Leg Syndrome and Insomnia

RLS usually gets worse at night

Restless leg syndrome is a feeling that has been described as “bugs crawling under my skin.” The only relief is movement, usually getting up and walking. RLS occurs frequently among people with PD. It often gets worse at night and can be a primary cause of insomnia. There is no single strategy to relieve RLS that works for everyone, but here are some points to consider.

• If RLS is keeping you awake, your doctor should rule out neuropathy and varicose veins. It’s also important to have your blood iron levels checked, as iron deficiency may be the cause. Some studies have shown decreased iron in the central nervous system. The four iron labs recommended are ferritin, percent saturation, total iron binding capacity, and serum iron. Deficiency of folate, B12, or magnesium is also possible, and should be ruled out.

• Certain medications can be the cause of RLS. Dopamine antagonists (neuroleptics and metoclopramide), tricyclic antidepressants, some selective serotonin reuptake inhibitors, lithium, and H2 blockers have led to RLS in some people. If you have RLS and use any of these, discuss this with your doctor.

Restless Leg Syndrome Relief

Ask your doctor about magnesium supplements. Magnesium is involved in muscle relaxation, and many people don’t get enough daily. A good supplement would be chelated magnesium glycinate. If your doctor agrees, try about 400 mg before bedtime. Also, if your body stores of magnesium are low, then vitamin D levels are likely to be low also, because magnesium is a cofactor for vitamin D production.

Some folks find that a hot bath helps; others benefit from a leg massage. Either heating pads or frozen gel packs have helped in other cases.

Drinking about 2-3 ounces of tonic water at bedtime has been useful for a number of people. Tonic water contains quinine, which affects the nervous system favorably.

Lavender essential oil rubbed on the skin can be effective for some people — temples, behind the ears, wrists, ankles, soles of the feet. You don’t have to be able to smell it for good results.

Lavender essential oil may help with insomnia

A good quality vitamin E supplement containing all the forms of vitamin E is another possibility.

Fruit for Sleep

Though not directly related to RLS, tart cherries contain serotonin, melatonin, and tryptophan, all of which help with relaxation and sleepiness. In one study, twenty subjects were given tart cherry juice concentrate or a placebo for seven days. Both length of sleep time, and quality of sleep were improved in the subjects taking cherry juice. 3 (Note: the study subjects did not have Parkinson’s disease.)

Another option is kiwifruit, which contain serotonin. In a study, 22 volunteers each ate two kiwifruit one hour before going to bed.

Kiwifruit has serotonin, which promotes sleep

After four weeks, researchers found that the subjects fell asleep sooner and slept more soundly, with less wakefulness; total sleep time increased by 13%.4 (Again, the study subjects did not have PD or RLS.)

And, finally, there is “folk wisdom.” Some people swear by:

– putting a bar of soap between the bedsheets

– eating a teaspoon of yellow mustard before bed

– avoiding caffeine in the evening

There are many other possible causes for insomnia and RLS for those with PD, and you should fully explore them with your doctor. But if natural means help, you may be able to manage without additional medications. In general, the fewer medications are needed, the less the likelihood of adverse side effects.

Comments?

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